Cost-Effectiveness of a Community-Based Diabetes Prevention Program with Participation Incentives for Medicaid Beneficiaries
Cost-Effectiveness of a Community-Based Diabetes Prevention Program with Participation Incentives for Medicaid Beneficiaries
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DOI：
10.1111/1475-6773.12973
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发表时间：
2018-12-01
影响因子：
3.4
通讯作者：
Desai, Jay
中科院分区：
文献类型：
--
作者：
Gilmer, Todd;O'Connor, Patrick J.;Desai, Jay
目的数据来源/研究背景从卫生保健部门的角度检查以社区为基础的糖尿病预防计划(DPP)对医疗补助受益人的成本效益。共有847名有2型糖尿病高危风险的医疗补助参与者参加了以社区为基础的DPP。研究设计数据收集/提取方法将临床前和临床后的结果和成本数据作为有效的糖尿病模拟模型的输入。该模型被用来从卫生保健部门的角度评估40年时间范围内的质量调整寿命年(QALY)和卫生保健成本。临床结果和成本数据来自一项研究，该研究检验了经济激励对减肥的影响。主要发现：研究参与者平均减掉4.2磅(p<；.001)，高密度脂蛋白胆固醇增加1.75 mg/dl(p=.002)。每名参与者的干预成本为915美元，其中包括对参与和减肥的经济激励。增量成本效益比估计为每QALY 14,011美元，但对所研究的时间范围很敏感。社区DPP的广泛采用有可能降低糖尿病高危低收入人群的糖尿病和心血管相关发病率和死亡率，可能是医疗补助计划的一项具有成本效益的投资。
Objective Data Sources/Study Setting To examine the cost-effectiveness of a community-based Diabetes Prevention Program (DPP) for Medicaid beneficiaries from the perspective of the health care sector. A total of 847 Medicaid enrollees at high risk for type 2 diabetes participating in a community-based DPP. Study Design Data Collection/Extraction Methods Pre- and post clinical outcome and cost data were used as inputs into a validated diabetes simulation model. The model was used to evaluate quality-adjusted life years (QALYs) and health care costs over a 40-year time horizon from the perspective of the health care sector. Clinical outcome and cost data were derived from a study examining the effect of financial incentives on weight loss. Principal Findings Conclusions Study participants lost an average of 4.2 lb (p < .001) and increased high-density lipoprotein cholesterol by 1.75 mg/dl (p = .002). Intervention costs, which included financial incentives for participation and weight loss, were $915 per participant. The incremental cost-effectiveness ratio was estimated to be $14,011 per QALY but was sensitive to the time horizon studied. Widespread adoption of community-based DPP has the potential to reduce diabetes and cardiovascular-related morbidity and mortality for low-income persons at high risk for diabetes and may be a cost-effective investment for Medicaid programs.